OP0267 THE PREDICTIVE ACCURACY OF CARDIOVASCULAR RISK PREDICTION TOOLS IN INFLAMMATORY ARTHRITIS
Authors: D. Hughes, S. S. Zhao
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Cardiovascular risk prediction tools designed for the general population often underestimate and occasionally overestimate cardiovascular risk in individuals with rheumatoid arthritis. Incidence of cardiovascular disease is also recognised to be increased in individuals with other inflammatory arthritides. <h3>Objectives</h3> To investigate performance of three common cardiovascular risk prediction tools (QRISK-3, Framingham Risk Score and Reynolds Risk Score) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). We also compare performance in patients with psoriasis, since it is closely related to PsA, and a non-inflammatory disease, osteoarthritis (OA). <h3>Methods</h3> We utilise primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database and identify individuals with diagnostic codes for each condition. We calculated their 10-year cardiovascular risk using each risk tool, and compared this to their observed outcomes. Discrimination (how well the tool separates CVD cases and non-cases) was assessed using time-dependent (to account for censoring in follow up) Area-under-ROC-curve (AUC), sensitivity, specificity, positive and negative predictive values (using 10% and 20% predicted risk to determine high risk of CVD). Calibration (how well predicted risks match observed risks) of each risk prediction tool was assessed by comparing the observed and predicted risks in deciles of predicted risk for each disease group. <h3>Results</h3> Time-dependent AUC for QRISK3 ranged between 0.697 for patients with osteoarthritis to 0.815 for patients with psoriasis, indicating reasonably good predictive performance (Figure 1). AUC for the Framingham Risk score were similar, whilst the Reynold's Risk Score achieved slightly lower AUCs in this cohort, ranging between 0.640 for patients with osteoarthritis and 0.752 for patients with psoriasis. In general, the Framingham Risk Score was reasonably well calibrated for each condition but underpredicted risk for patients with RA or OA. The Reynold's Risk Score tended to underpredict CVD risk, whilst the QRISK3 score overpredicted CVD risk, especially for the most high-risk individuals. <h3>Conclusion</h3> In general, CVD risk for individuals with RA, AS, PsA, psoriasis, or OA were less accurately predicted using each of the 3 CVD risk prediction tools than the reported accuracies in the original publications. There is a need for specific risk prediction tools for rheumatic conditions. <h3>Acknowledgements</h3> This study was supported by a grant from a charitable organisation, the Psoriasis and Psoriatic Arthritis Alliance (PAPAA). <h3>Disclosure of Interests</h3> David Hughes Grant/research support from: This study was supported by a grant from a charitable organisation, the Psoriasis and Psoriatic Arthritis alliance (PAPAA)., Sizheng Steven Zhao Grant/research support from: This study was supported by a grant from a charitable organisation, the Psoriasis and Psoriatic Arthritis alliance (PAPAA).